Abstract:Objective To explore the value of a multidisciplinary team（MDT）approach in sequential surgical resection of intermediate and advanced hepatocellular carcinoma（HCC）after conversion therapy of targeted therapy combined with immunotherapy. Methods A retrospective analysis was conducted on a case of initially unresectable massive HCC of right liver treated in the Hepatobiliary and Pancreatic Surgery Department of Qujing No.1 Hospital in May 2021. After MDT discussion，an individualized treatment plan was formulated and successfully implemented，leading to surgical resection. Results （1）First MDT discussion：due to a tumor diameter of approximately 12 cm and invasion of the right and middle hepatic veins，the tumor was deemed unresectable in one stage. A treatment plan involving targeted therapy，immunotherapy，antiviral therapy，and liver protection was initiated. After 9 cycles of combined targeted and immunotherapy，the tumor diameter shrank from 12.0 cm to 6.0 cm，and the tumor thrombus in the right and middle hepatic veins completely disappeared，demonstrating significant conversion efficacy.（2）Second MDT discussion：the combined targeted and immunotherapy successfully down -staged the tumor，making radical surgical resection feasible.After thorough preoperative preparation，an anatomical middle hepatectomy （S5，S8） and cholecystectomy were performed under general anesthesia in February 2022. Postoperative pathological examination showed no viable cancer cells in the resected liver tissue，with a tumor regression grade of 0（complete response）. No tumor thrombus was found in the vessels，and the tumor did not involve the capsule or surgical margins，achieving pathological complete remission.（3） Third MDT discussion：postoperative examination revealed no tumor cells，confirming pathological complete remission. The regular adjuvant targeted and immunotherapy was continued for one year. As of 24 months post -surgery，there has been no tumor recurrence or metastasis，and the patient has remained in good general condition. Conclusion MDT provides significant clinical value in the diagnosis and treatment of intermediate and advanced HCC. It is of great clinical significance in formulating reasonable individualized treatment plans for such patients，sequential radical surgery after conversion treatment，selecting appropriate adjuvant treatment models based on the degree of pathological reactions after surgery，and prolonging patient survival.